Specific Properties of Atypical Antidepressants

Buproprion - minimal sexual side effects

minimal cardiac effects, in contrast to tricyclics, which produce EKG changes

short half-life – 10 hours

stimulating; can cause tremors and psychosis

SR form does not have increased risk of seizures

Mirtazepine - a₂ and 5HT receptor blockade

sedation and weight gain are common

Venlafaxine - active metabolites, but minimal P450 activity

short half-life – 5 h

only 30% protein bound – big difference from many of the other antidepressants found;

those that are highly protein bound run into risks of drug-drug interactions

nausea, sedation, and dry mouth are common

risk of increased diastolic BP

minimal sexual side effects at doses <>

Nefazodone - acts on a₁ and 5HT receptors

active metabolites

short half-life – 4 h

inhibits CYP 3A3/4 (BDZ, H2 blockers)

minimal anxiety or sexual side effects

some sedation, dry mouth, nausea, dizziness

Trazodone - acts on 5HT_1B and 5HT_2A/2C receptors

active metabolites – m-CPP

short half-life – 5 h

weak antidepressant effects

extremely sedating

priapism in males, even at low doses

Overall, atypical agents have low toxicity in overdose and lower rates of sexual dysfunction than SSRIs.

Category: Pharmacology Notes